The World Health Organization declared the outbreak of coronavirus disease 2019 (COVID-19) as a pandemic on March 11, 2020.1 In Japan, a request for school closure throughout the nation was announced by the government on March 2, lasting until June in some areas. Furthermore, a nationwide state of emergency, which requested that citizens stay at home as much as possible, was declared from April 7 to May 25. Previous studies estimated that > 90% of children with COVID-19 had relatively mild symptoms.2-4 Nevertheless, measures taken to prevent the transmission of the virus, such as physical distancing, lockdown strategies, and school closures, can place burdens on children in multiple ways. United Nations (UN) alerts reported that such burdens include poverty, infant mortality, educational deprivation, malnutrition due to discontinuation of school meals, violence, and abuse, which all have future impacts on their development and well-being.5

In 1991, Japan ratified the United Nations Convention of the Rights of the Child (CRC)6 and promised to uphold the basic rights of every child. Previous research has suggested that the pandemic is harming the rights of the child.7-11 The Committee on the Rights of the Child (hereafter, the Committee) has warned that children's rights are affected by the health, social, educational, economic, and recreational impacts of the pandemic, especially among children under states of emergency or lockdowns.7

Even in such a crisis, children are capable of actively engaging in advocating for social change.12 Only a few studies have explained how this pandemic has affected children's rights based on children's voices,12, 13 and there are no such reports to date to describe the situation in the Japanese context. Exploring the impact of the pandemic from the children's perspective within the CRC, the internationally shared legal framework, can contribute to better understand the best interests of children and place children's rights at the center of the COVID-19 response. This study aimed to explore how the rights in the CRC have been restricted during this pandemic, based on children's self-reports from a web-based survey. We also describe what actions we took in our project in response to the voices obtained from this study.

Methods Data collection

Data were collected as a part of the CORONA-CODOMO Survey (CODOMO means “children” in Japanese), administered mainly by the National Center for Child Health and Development (NCCHD) in Japan. The project aims to measure the health and wellbeing of children and families during the COVID-19 crisis and to provide related information to children, families, and professionals who work with children. A web-based, multi-phased anonymous survey was conducted in children aged 7–17 and parents/guardians of children aged 0–17. The age range of children included in the study was based on ethical considerations14 and the definition of children by the CRC.6 Further details of the study are described elsewhere.15 We chose to present the results obtained in the first phase, in which participants were recruited from April 30 to May 31, 2020, to assess the impact of the state of emergency and school closure on children during the early phase of the pandemic. The survey was advertised in multiple ways, including on our website (https://www.ncchd.go.jp/center/activity/covid19_kodomo/survey.html#3tab), through social media, and via distribution through child-related organizations. Children could participate by themselves or with their parents/guardians. For a child to participate, the consent of the parents/guardians was required regardless of parents/guardians' participation. When both the parent and the child participated, the questionnaire for the parents was administered first, followed by that for the children.

Study subjects

A total of 6,116 parents/guardians and 2,591 children participated in the survey. In this study, we focused on children who responded to at least one of two open-ended questions (described in the section below). Among those who responded (n = 1,337), we excluded children who responded “no needs” or “no comments” (n = 45). The remaining 1,292 children (49.9% of the total child participants) made up our analytic sample (Fig. 1).

Study subjects. Of the 6,116 parents/guardians and 2,591 children who participated in the survey during this study period, we focused on children who responded to at least one of the two open-ended questions. A total of 1,254 children did not provide any response to the two questions. Among those who provided comments, children who wrote either “no needs” or “no comments” were excluded (n = 45). The remaining 1,292 children made up our analytic sample.

Questions in the survey

The questionnaire for children consisted of 38 questions for children and 11 demographic questions for children or parents/guardians. When a child participated alone, he/she replied to 49 questions, whereas children answered only 38 questions if their parents/guardians were involved. Of the 38 questions, 36 had multiple answer choices and pertained to life and behavior during the quarantine, psychological symptoms (depression, anxiety, and stress), wellbeing, quality of life, positive parenting, and abusive behaviors. The remaining two questions were open ended, allowing children to explore their views and opinions about what they wished to know or currently wanted (Q1) and questions or concerns about the survey (Q2).

Measurement variables

We assessed the following demographic variables among the participants: gender (male, female, other, do not want to answer), grade at school (grade 1–12, other, do not want to answer), family structure (living with both parents or not, number of siblings), maternal employment status, and home location (i.e., region of Japan). In Japan, grades 1–6 correspond to elementary school (ages 6–12), grades 7–9 to junior high school (ages 12–15), and grades 10–12 to high school (ages 15–18). In our study, participants were grouped into age categories according to their grade (i.e., grades 1–3, 4–6, and 7–12), since children may respond differently to questions according to developmental stage.

CRC areas investigated

Based on previous reports, we focused on the following five categories of rights defined by the CRC in this study: education, health, safety, play, and participation.7, 8 From among the CORONA-CODOMO Survey questions that had multiple choices, this study chose 15 representing the above categories, as shown in Table 1.

Table 1. Categories of rights outlined in the United Nations Convention on the Rights of the Child (CRC) and the related questions in the survey Rights Articles in the CRC Related questions and answer choices in the survey Education

28 (access to education)

29 (aims of education)

Please choose all that apply to your complaint: “I cannot go to school (1),” “I am worried about studying (2),” “I cannot see my friends,” “I cannot play outside,” “I cannot be physically active,” “none of the above.”

Compared to last year, your study hours; “increased,” “same,” “decreased (3),” “do not know or do not want to answer.”

Health

6 (life, survival, and development)

24 (health and health services)

Please choose all that apply to what you are anxious about: “I am worried that I may catch COVID-19 (4),” “I am worried someone in my family may catch COVID-19 (5),” “I want to know more about COVID-19,” “I am really afraid of COVID-19 (6),” “none of the above.” Safety 19 (protection from violence, abuse, and neglect) Please choose all that apply to you at home: being “slapped (7),” “threatened/insulted (8),” “yelled at (9),” “not given necessities, such as food (10),” “none of the above.” Play

15 (association)

31 (leisure, play, and culture)

Please choose all that apply to your complaint: “I cannot go to school,” “I am worried about studying,” “I cannot see my friends (11),” “I cannot play outside (12),” “I cannot be physically active,” “none of the above.”

Communication with friends: Choose all of the following that applied to you in the last week:

“face to face,” “via phone,” “via video chat,” “via text messaging,” “did not have any contact at all (13).”

Participation

12 (respect for the views of the child)

13 (freedom of expression)

17 (access to information)

Please choose all that apply to your parents/guardians: “use easy-to-understand words to explain (14),” “understand my feelings,” “always listen to me.”

“making me feel easy,” “none of the above.”

Please choose all that apply to what you are anxious about: “I am worried that I may catch COVID-19,” “I am worried someone in my family may catch COVID-19,” “I want to know more about COVID-19 (15),” “I am really afraid of COVID-19,” “none of the above.”

Bold text shows the 15 answer choices used for the analysis. Data analysis

First, we conducted descriptive analyses of our study participants and compared them with individuals who were excluded. Second, for the questions related to the rights described in the CRC, we determined the proportion that was answered in the affirmative. Finally, as the main focus of the study, we narratively reviewed all children's direct responses to the two open-ended questions, and the first author (A.Y.) categorized the comments according to the five CRC areas specified above. Co-authors separately reviewed each comment and selected the representative comments based on the frequency of similar comments, the relevance to the CRC, and also to reflect the responses of participants with age categories according to their grades.

Ethical considerations

The study has full ethical and data protection approved by the Institutional Review Board of the NCCHD (approval number 2020–21.) For a child to participate in the study, consent had to be obtained from both the child (aged 7–17 years) and his/her parents/guardians. Each child was ensured the opportunity not to answer the questions, or to discontinue responding at any time.

Results Participant characteristics and proportions of affirmative answers to questions regarding rights under the CRC

Among the 2,591 children who participated, 1,292 (49.9%) gave valid responses to at least one of the two open-ended questions. Table 2 shows the demographics of the study subjects (n = 1,292). Overall, 63.9% of the children identified as female. The percentages of children in grades 1–3, 4–6, and 7–12 were 24.9%, 46.7%, and 22.9%, respectively. While nearly half of the children were from Tokyo and the nearby Kanto region, there were children from 46 of the 47 prefectures in Japan. Relative to children who did not provide a valid answer to the open-ended questions, children who provided comments were more likely to be female, to be in grades 4–6, and to have mothers who worked part time or were self-employed.

Table 2. Demographics of children who did or did not provide comments in the survey Total Provided comments† Did not provide comments P-value‡ (n = 2,591) (n = 1,292) (n = 1,299) n % n % n % Child Gender Female 1,550 59.8% 825 63.9% 725 55.8% <0.001 Male 978 37.7% 435 33.7% 543 41.8% Other/do not want to answer 63 2.4% 32 2.5% 31 2.4% Grade§ Grades 1–3 (ages 7–9) 631 24.4% 322 24.9% 309 23.8% <0.001 Grades 4–6 (ages 9–12) 1,114 43.0% 604 46.7% 510 39.3% Grades 7–12 (ages 12–17) 676 26.1% 296 22.9% 380 29.3% Other/do not want to answer 170 6.6% 70 5.4% 100 7.7% Household Parents Living with two parents 2,246 86.7% 1.123 86.9% 1.123 86.5% 0.454 Living with one parent, other 308 11.9% 147 11.4% 161 12.4% Unknown/do not want to answer 37 1.4% 22 1.7% 15 1.2% Siblings Only child 706 27.2% 372 28.8% 334 25.7% 0.219 Two children 1,312 50.6% 640 49.5% 672 51.7% Three+ children 543 21.0% 266 20.6% 277 21.3% Unknown/do not want to answer 30 1.2% 14 1.1% 16 1.2% Maternal employment Full time 369 14.2% 207 15.9% 162 12.5% 0.048 Part-time, self-employed 1,393 53.8% 720 55.7% 673 51.8% Housewife, unemployed 765 29.5% 375 29.0% 390 30.0% No mother/do not want to answer 64 2.5% 35 2.7% 29 2.2% Home location Hokkaido 39 1.5% 15 1.2% 24 1.8% 0.345 Tohoku region 31 1.2% 13 1.0% 18 1.4% Kanto region (except Tokyo) 555 21.4% 267 20.7% 288 22.2% Tokyo 639 24.7% 328 25.4% 311 23.9% Chubu region 139 5.4% 74 5.7% 65 5.0% Kinki region 189 7.3% 98 7.6% 91 7.0% Chugoku region 45 1.7% 19 1.5% 26 2.0% Shikoku region 11 0.4% 5 0.4% 6 0.5% Kyusyu region 80 3.1% 32 2.5% 48 3.7% Missing 863 33.3% 422 32.5% 422 32.5%

Table 3 shows the proportions of affirmative answers to questions based on the rights under the CRC for all 1,292 children. While the most frequent concern for education was not being able to go to school among younger children (69.3% for grades 1–3, 67.9% for grades 4–6), for children in grades 7–12 the main worry was about having difficulty studying (67.2%, n = 199). Regarding health, children were more concerned that family members might be infected (78.2%, n = 1,010) than that they would be infected (71.3%, n = 921). Younger children tended to be more afraid of becoming infected. To assess children's safety, we asked whether they had experienced physical or psychological abuse at home. Overall, 9.2% (n = 119) said they had been threatened or insulted, 15.9% (n = 205) said they had been yelled at, and 7.4% (n = 95) said they had been exposed to physical abuse. Children in grades 1–3 experienced each form of abuse more frequently. Not being able to see friends was the second most frequent concern of children (74.3%, n = 960), and younger children tend to have less contact with friends (46.3% for grades 1–3.)

Table 3. Proportions of affirmative answers regarding rights related to the CRC among children who provided comments in the survey (N = 1,292) Rights† Related answer choices of the survey‡ Total Grade1–3 Grade4–6 Grade7–12 (n = 1,292) (n = 322) (n = 604) (n = 296) n % n % n % n % Education I cannot go to school 855 66.2% 223 69.3% 410 67.9% 176 59.5% I am worried about studying 732 56.7% 161 50.0% 337 55.8% 199 67.2% Time spent for studying was decreased 281 21.7% 59 18.3% 123 20.4% 85 28.7% Health I am worried that I may get the coronavirus 974 75.4% 245 76.1% 468 77.5% 208 70.3% I am worried that a member of my family may get the coronavirus 1,068 82.7% 270 83.9% 508 84.1% 232 78.4% The coronavirus is very scary 753 58.3% 204 63.4% 369 61.1% 141 47.6% Safety I was hit or beaten (physical abuse) 104 8.0% 46 14.3% 35 5.8% 14 4.7% I was threatened or insulted (psychological abuse) 131 10.1% 36 11.2% 54 8.9% 29 9.8% I was yelled at (psychological abuse) 220 17.0% 77 23.9% 92 15.2% 36 12.2% I am not given necessities, such as food. 7 0.5% 2 0.6% 3 0.5% 2 0.7% Play I cannot meet my friends 1,013 78.4% 269 83.5% 486 80.5% 205 69.3% I cannot play outside 703 54.4% 189 58.7% 336 55.6% 139 47.0% I have not kept contact with friends 502 38.9% 149 46.3% 256 42.4% 63 21.3% To be heard Parents explain things with easy words 710 55.0% 199 61.8% 341 56.5% 130 43.9% I want to know more about the coronavirus 645 49.9% 166 51.6% 320 53.0% 131 44.3% There were 70 children who did not answer their grade. Children's direct comments related to rights under the CRC

A total of 1,523 comments were obtained for the two open-ended questions. The number of comments regarding the categories of rights under the CRC is listed in Table S1, along with selected comments.

Education There were 248 comments related to education. Fifty-seven mentioned concerns about the timing of school re-openings. Thirty-seven children expressed a wish to go to school soon. On the other hand, some children, including those who had refused to attend school in the past, expressed concern about returning to school. Some feared becoming infected, whereas others were anxious about adapting to a new life after school reopening. Many children mentioned that they wanted to go to school not only for academic reasons but also for seasonal events (e.g., school trips and sports competitions) or club activities that would have been held if the COVID-19 pandemic had not occurred. Many older children gave comments about their upcoming entrance examinations for new schools and were worried about how they were going to be held (37 comments). Some children were concerned about the disparity in learning associated with different measures among schools; for example, one 12th-grade boy said,

I have entrance examinations this year, but our classes have been canceled. Meanwhile, other schools provide students with online classes. I am anxious that the disparity between students will widen, and I want to know what I can do about it.

Health Among 381 comments related to health, 344 included concerns and questions about COVID-19 itself. The majority expressed a need for more information, such as when the crisis would be over or how COVID-19 could be eliminated. Some children with chronic conditions were concerned that their symptoms would be exacerbated by COVID-19. Others worried that they might be stigmatized because they had a cough or runny nose due to pre-existing medical conditions. For example:

I have asthma, a disease involving my skin, and a runny nose because of an allergy or something. I am worried that I may be bullied because others think I have COVID-19, and I am a little scared of going to school. (Girl, 6th grade)

Many children were aware that their mental health was also threatened. Some said they wanted to know how to relax or cope with their stress.

Safety

There were 13 comments about safety, especially involving children's families. Most children did not directly mention violence, abuse, or neglec